How does epidemiological and clinicopathological features affect survival after gastrectomy for gastric cancer patientssingle Egyptian center experience

AIM:To investigate the clinicopathological features and the significance of different prognostic factors which predict surgical overall survival in patients with gastric carcinoma.METHODS:This retrospective study includes 80 patients diagnosed and treated at gastroenterology surgical center,Mansoura University,Egypt between February 2009 to February 2013.Prognostic factors were assessed by cox proportional hazard model.RESULTS:There were 57 male and 23 female.The median age was 57 years(24-83).One,3 and 5 years survival rates were 71%,69% and 46% respectively.The median survival was 69.96 mo.During the follow-up period,13 patients died(16%).Hospital morbidity was reported in 10 patients(12.5%).The median number of lymph nodes removed was 22(4-41).Lymph node(LN) involvement was found in 91% of cases.After R0 resection,depth of wall invasion,LN involvement and the number(> 15) of retrieved LN,LN ratio and tumor differentiation predict survival.In multivariable analysis,tumor differentiation,curability of resection and a number of resected LN superior to 15 were found to beindependent prognostic factors.CONCLUSION:Surgery remains the cornerstone of treatment.Tumor differentiation,curability of resection and a number of resected LN superior to 15 were found to be independent prognostic factors.Extended LN dissection does not increase the morbidity or mortality rate but markedly improves long term survival.

Effect of radical surgery combined with pre- or postoperative radiotherapy in treatment of resectable rectal cancer

Objective： This study was done to compare between the effect of preoperative radiotherapy and postoperative radiotherapy in treatment of resectable rectal carcinoma. The primary endpoints are local recurrence rate, overall survival （OS） and disease free survival （DFS）. The secondary endpoints are to evaluate down-staging, treatment toxicity, and ability to do sphincter preservation, aiming at choosing the optimal treatment modality. Methods： This study included 100 patients with resectable rectal carcinoma who presented to Surgical Gastro Entrology Center and Clinical Oncology and Nuclear Medicine Department, Mansoura University during the period between January 2007 and September 2009. The included patients were randomized in two groups; group h 50 patients received preoperative radiotherapy and group Ih 50 patients received post- operative radiotherapy. Concurrent 5-fluorouracil-based chemotherapy was given to all patients. Two major types of surgery were done： abdomino-perineal resection with a permanent colostomy and low anterior resection with colorectal or coloanal anastomosis. Results： Preoperative radiotherapy resulted in pathologic complete response in 3 patients. T down-staging occurred in 18 out of 50 patients （36%） with statistically significant difference （P = 0.008）. N down-staging occurred in 10 out of 24 patients. Sphincter preservation was more in group I. Delayed wound healing was the most common postoperative complication in group I with no significant difference. After a median follow up of 18 months, local recurrence rate and distant metastasis were higher in group I1. The 2-year disease free survival was 72% and 60% in group I and II respectively with no statistically significant difference between both groups. Conclusion： This study concluded that preoperative radiotherapy is better than postoperative radiotherapy as regard local control, sphincter preservation with higher disease free survival and overall survival. No difference in treatment toxicity between both groups.